- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,390.19 / $4,298.00 / $8,074.63
| Facility | | $2,390.19 | $4,298.00 | $8,074.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,386.42 / $2,754.06 / $4,477.89
| Professional | | $2,386.42 | $2,754.06 | $4,477.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,329.50 / $16,401.00 / $29,216.95
| Facility | | $8,329.50 | $16,401.00 | $29,216.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,481.66 / $3,394.14 / $5,311.45
| Professional | | $2,481.66 | $3,394.14 | $5,311.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,046.28 / $3,046.28 / $4,245.84
| Facility | | $3,046.28 | $3,046.28 | $4,245.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,593.80 / $3,845.72 / $6,397.79
| Professional | | $2,593.80 | $3,845.72 | $6,397.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.00 / $3,325.00 / $8,198.00
| Facility | | $1,292.00 | $3,325.00 | $8,198.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,437.48 / $3,572.63 / $6,507.48
| Professional | | $2,437.48 | $3,572.63 | $6,507.48 |